Medicaid experiment flaws seen

Pilot program expansion should be delayed, report says

October 17, 2007|By Bob LaMendola Staff Writer

Florida should delay expanding its year-old Medicaid reform experiment - under way in a pilot program area including Broward County - until it can solve flaws hindering patients, says the state's first major evaluation of the program.

Medicaid's inspector general reported that the new system of HMO-style coverage made it hard for Medicaid's low-income recipients to choose the most suitable health plan, forcing some to change doctors and run out of drug coverage. It's too soon to tell if the program is saving money or improving health care overall, the report said.

"Further expansion of Medicaid Reform should be delayed until such time as those improvements are met" and the program's health-care quality can be analyzed, Inspector General Linda Keen wrote in the report.

Patient advocates hailed the report, saying it confirms a year of complaints that the new system has degraded medical care for some recipients, especially those who are the most sick.

"These are serious problems. This is from their own people, talking to their own people," said Miriam Harmatz, an attorney for Florida Legal Services, in Miami, who covers Broward County. "The agency has got to make sure these issues are addressed ... before we go forward."

The nationally watched reform plan aims to save billions and give the state's 2.3 million Medicaid recipients better health care by moving them into private health plans. The experiment started a year ago for 120,000 people in Broward, 80,000 in Jacksonville and recently about 10,000 in three rural counties. State officials must report to the Legislature next year on progress toward expanding statewide.

Dr. Andrew Agwunobi, secretary of the Agency for Health Care Administration, which runs Florida Medicaid, said Wednesday the report raised doubts but he has not decided whether to recommend slowing down the expansion. The original plan called for starting statewide expansion as soon as late 2008.

"We need to evaluate a lot more information," Agwunobi said. The report showed the state may need more resources to fix the problems, he said, at a time when spending is tight.

The new report found problems with:

Medicine . Some recipients with complex illnesses used up drug coverage and were left uncovered. The state fined one plan for not disclosing its limits, but did not let patients switch plans.

Choosing . Recipients were hampered trying to pick the best health plan, because 12 of 17 insurers made it impossible or difficult to find out which drugs are covered, and their doctor lists were riddled with errors.

Specialists. Many recipients struggled to find specialists, also a problem in regular Medicaid.

Complaints. The state has received few complaints about the reform, partly because there is no complaint system.

Bob LaMendola can be reached at blamendola@sun-sentinel.com or 954-356-4526 or 561-243-6600, ext. 4526.